C-61 | Role of Intravenous Iron for Iron Deficiency in Patients With Systolic Heart Failure

Iron deficiency is associated with worse clinical outcomes in patients with heart failure (HF). As studies have shown conflicting results with intravenous (IV) iron in systolic HF, we aimed to conduct an updated meta-analysis to reconcile the available data. Randomized controlled trials (RCTs) comparing IV iron to usual care/placebo for iron deficiency in patients with systolic HF (left ventricular ejection fraction < 50%) were searched from online databases. The outcomes of interest were all-cause death, cardiovascular (CV) death, HF hospitalizations and serious adverse events (SAEs). Pooled odds ratios (OR) and 95% confidence intervals (CI) were calculated using a random-effects model. Eleven RCTs with a total of 6,478 patients (IV iron n=3,325, usual care n=3,153) were included. The mean age was 68 years, 63% patients were men and the mean duration of follow up was 43 weeks. As compared with usual care, HF patients receiving IV iron for iron deficiency had significant reduction in HF hospitalizations (OR 0.60, 95% CI 0.45 to 0.79, p = 0.0003) (Figure). The two groups were similar with respect to all cause death (OR 0.93, 95% CI 0.81 to 1.06, p = 0.29), CV death (OR 0.88, 95% CI 0.77 to 1.01, p = 0.08) and SAEs (OR 0.83, 95% CI 0.68 to 1.00, p = 0.05). In line with the recent European Society of Cardiology (ESC) guidelines (class IIa, level A), our updated meta-analysis of RCTs shows improvement in HF hospitalizations with IV iron in patients with iron deficiency and systolic HF.